Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 62-year-old man undergoes elective total hip arthroplasty. On postoperative day 5, he develops fever (38.9°C), tachycardia (HR 102 bpm), and purulent drainage from the surgical incision. Blood and wound cultures grow methicillin-sensitive Staphylococcus aureus (MSSA). He received appropriate cefazolin prophylaxis 60 minutes preoperatively. A root cause analysis team identifies five potential contributors to this surgical site infection: (1) inadequate preoperative skin antisepsis with chlorhexidine, (2) three unscheduled OR personnel entries during the procedure, (3) operative time of 95 minutes, (4) postoperative dressing changes performed with non-sterile technique on days 2 and 3, and (5) lack of antimicrobial-coated sutures. Which quality improvement tool is most appropriate for the team to use to systematically identify the PRIMARY underlying cause rather than treating all factors equally?
Answer choices
- APareto chart showing the frequency distribution of potential causative factors ranked by likelihood
- BPerforming a prospective case-control study comparing antibiotic sensitivity patterns in this patient versus historical MSSA isolates
- CImmediately implementing interventions targeting all five identified factors simultaneously across all surgical procedures
- DFishbone (Ishikawa) diagram to visualize relationships among people, process, equipment, and environment factorsCorrect answer
- EReviewing regulatory compliance documentation and Joint Commission standards for surgical prophylaxis
- FSurveying the surgical team members to determine which factor they believe contributed most to the infection
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